Healthy Living & Healthy Aging Research
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EULAR revised recommendations for the management of fibromyalgia

EULAR revised recommendations for the management of fibromyalgia | Healthy Living & Healthy Aging Research | Scoop.it

(Available in free full text ... and note the strong recommendation for both aerobic & strengthening exercises) Objective The original European League Against Rheumatism recommendations for managing fibromyalgia assessed evidence up to 2005. The paucity of studies meant that most recommendations were ‘expert opinion’.  Methods A multidisciplinary group from 12 countries assessed evidence with a focus on systematic reviews and meta-analyses concerned with pharmacological/non-pharmacological management for fibromyalgia. A review, in May 2015, identified eligible publications and key outcomes assessed were pain, fatigue, sleep and daily functioning. The Grading of Recommendations Assessment, Development and Evaluation system was used for making recommendations.  Results 2979 titles were identified: from these 275 full papers were selected for review and 107 reviews (and/or meta-analyses) evaluated as eligible. Based on meta-analyses, the only ‘strong for’ therapy-based recommendation in the guidelines was exercise. Based on expert opinion, a graduated approach, the following four main stages are suggested underpinned by shared decision-making with patients. Initial management should involve patient education and focus on non-pharmacological therapies. In case of non-response, further therapies (all of which were evaluated as ‘weak for’ based on meta-analyses) should be tailored to the specific needs of the individual and may involve psychological therapies (for mood disorders and unhelpful coping strategies), pharmacotherapy (for severe pain or sleep disturbance) and/or a multimodal rehabilitation programme (for severe disability).  Conclusions These recommendations are underpinned by high-quality reviews and meta-analyses. The size of effect for most treatments is relatively modest. We propose research priorities clarifying who will benefit from specific interventions, their effect in combination and organisation of healthcare systems to optimise outcome.

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Estimation of the dietary requirement for vitamin D in adolescents aged 14–18 y: a dose-response, double-blind, randomized placebo-controlled trial

Background: Adolescents are a population group at high risk of low vitamin D status, yet the evidence base for establishing dietary vitamin D requirements remains weak.  Objective: The aim was to establish the distribution of vitamin D intakes required to maintain serum 25-hydroxyvitamin D [25(OH)D] concentrations above proposed cutoffs (25, 30, 40, and 50 nmol/L) during winter in white males and females (14–18 y of age) in the United Kingdom (51°N).  Design: In a dose-response trial, 110 adolescents (aged 15.9 ± 1.4 y; 43% males) were randomly assigned to receive 0, 10, or 20 μg vitamin D3 supplements/d for 20 wk during winter. A nonlinear regression model was fit to total vitamin D intake and postintervention serum 25(OH)D concentrations, and regression-predicted values estimated the vitamin D intakes required to maintain serum 25(OH)D concentrations above specific cutoffs.  Results: Mean ± SD serum 25(OH)D concentrations increased from 49.2 ± 12.0 to 56.6 ± 12.4 nmol/L and from 51.7 ± 13.4 to 63.9 ± 10.6 nmol/L in the 10- and 20-μg/d groups, respectively, and decreased in the placebo group from 46.8 ± 11.4 to 30.7 ± 8.6 nmol/L (all P ≤ 0.001). Vitamin D intakes required to maintain 25(OH)D concentrations >25 and >30 nmol/L in 97.5% of adolescents were estimated to be 10.1 and 13.1 μg/d, respectively, and 6.6 μg/d to maintain 50% of adolescents at concentrations >40 nmol/L. Because the response of 25(OH)D reached a plateau at 46 nmol/L, there is uncertainty in estimating the vitamin D intake required to maintain 25(OH)D concentrations >50 nmol/L in 97.5% of adolescents, but it exceeded 30 μg/d.  Conclusion: Vitamin D intakes between 10 and 30 μg/d are required by white adolescents during winter to maintain serum 25(OH)D concentrations >25–50 nmol/L, depending on the serum 25(OH)D threshold chosen.

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High red meat intake and all-cause cardiovascular and cancer mortality: is the risk modified by fruit and vegetable intake?

Background: High red meat consumption is associated with a shorter survival and higher risk of cardiovascular disease (CVD), cancer, and all-cause mortality. Fruit and vegetable (FV) consumption is associated with a longer survival and lower mortality risk. Whether high FV consumption can counterbalance the negative impact of high red meat consumption is unknown.  Objective: We evaluated 2 large prospective cohorts of Swedish men and women (the Swedish Mammography Cohort and the Cohort of Swedish Men) to determine whether the association between red meat consumption and the risk of all-cause, CVD, and cancer-specific mortality differs across amounts of FV intake.  Design: The study population included 74,645 Swedish men and women. Red meat and FV consumption were assessed through a self-administered questionnaire. We estimated HRs of all-cause, CVD, and cancer mortality according to quintiles of total red meat consumption. We next investigated possible interactions between red meat and FV consumption and evaluated the dose-response associations at low, medium, and high FV intake.  Results: Compared with participants in the lowest quintile of total red meat consumption, those in the highest quintile had a 21% increased risk of all-cause mortality (HR: 1.21; 95% CI: 1.13, 1.29), a 29% increased risk of CVD mortality (HR: 1.29; 95% CI: 1.14, 1.46), and no increase in the risk of cancer mortality (HR: 1.00; 95% CI: 0.88, 1.43). Results were remarkably similar across amounts of FV consumption, and no interaction between red meat and FV consumption was detected.  Conclusion: High intakes of red meat were associated with a higher risk of all-cause and CVD mortality. The increased risks were consistently observed in participants with low, medium, and high FV consumption.

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Effect of Marriage on Risk for Onset of Alcohol Use Disorder

Effect of Marriage on Risk for Onset of Alcohol Use Disorder | Healthy Living & Healthy Aging Research | Scoop.it

Objective: The authors sought to clarify the relationship between marriage and risk for alcohol use disorder.  Method: The association between marital status and risk for first registration for alcohol use disorder in medical, criminal, and pharmacy registries was assessed in a population-based Swedish cohort (N=3,220,628) using longitudinal time-dependent survival and co-relative designs.  Results: First marriage was associated with a substantial decline in risk for onset of alcohol use disorder in men (hazard ratio=0.41, 95% CI=0.40–0.42) and women (hazard ratio=0.27, 95% CI=0.26–0.28). This association was slightly stronger when the spouse had no lifetime alcohol use disorder, while marriage to a spouse with lifetime alcohol use disorder increased risk for subsequent alcohol use disorder registration in both men (hazard ratio=1.29, 95% CI=1.16–1.43) and women (hazard ratio=1.18, 95% CI=1.06–1.30). In both sexes, the protective effect of marriage was significantly stronger in those with than those without a family history of alcohol use disorder. In both men and women, the associations between marriage and risk for alcohol use disorder in cousins, half siblings, full siblings, and monozygotic twins discordant for marital status were as strong as that seen in the general population.  Conclusions: First marriage to a spouse with no lifetime alcohol use disorder is associated with a large reduction in risk for alcohol use disorder. This association cannot be explained by standard covariates or, as indicated by co-relative analyses, familial genetic or shared environmental confounders. These results are consistent with the hypothesis that the psychological and social aspects of marriage, and in particular health-monitoring spousal interactions, strongly protect against the development of alcohol use disorder. The protective effects of marriage on risk for alcohol use disorder are increased in those at high familial risk for alcoholism.

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Cannabis Use and Physical Health Problems in Early Midlife

Cannabis Use and Physical Health Problems in Early Midlife | Healthy Living & Healthy Aging Research | Scoop.it

Importance  After major policy changes in the United States, policymakers, health care professionals, and the general public seek information about whether recreational cannabis use is associated with physical health problems later in life.  Objective  To test associations between cannabis use over 20 years and a variety of physical health indexes at early midlife.  Design, Setting, and Participants  Participants belonged to a representative birth cohort of 1037 individuals born in Dunedin, New Zealand, in 1972 and 1973 and followed to age 38 years, with 95% retention (the Dunedin Multidisciplinary Health and Development Study). We tested whether cannabis use from ages 18 to 38 years was associated with physical health at age 38, even after controlling for tobacco use, childhood health, and childhood socioeconomic status. We also tested whether cannabis use from ages 26 to 38 years was associated with within-individual health decline using the same measures of health at both ages.  Exposures  We assessed frequency of cannabis use and cannabis dependence at ages 18, 21, 26, 32, and 38 years.Main Outcomes and Measures  We obtained laboratory measures of physical health (periodontal health, lung function, systemic inflammation, and metabolic health), as well as self-reported physical health, at ages 26 and 38 years.Results  The 1037 study participants were 51.6% male (n = 535). Of these, 484 had ever used tobacco daily and 675 had ever used cannabis. Cannabis use was associated with poorer periodontal health at age 38 years and within-individual decline in periodontal health from ages 26 to 38 years. For example, cannabis joint-years from ages 18 to 38 years was associated with poorer periodontal health at age 38 years, even after controlling for tobacco pack-years (β = 0.12; 95% CI, 0.05-0.18; P &lt;.001). Additionally, cannabis joint-years from ages 26 to 38 years was associated with poorer periodontal health at age 38 years, even after accounting for periodontal health at age 26 years and tobacco pack-years (β = 0.10; 95% CI, 0.05-0.16; P < .001) However, cannabis use was unrelated to other physical health problems. Unlike cannabis use, tobacco use was associated with worse lung function, systemic inflammation, and metabolic health at age 38 years, as well as within-individual decline in health from ages 26 to 38 years.  Conclusions and Relevance  Cannabis use for up to 20 years is associated with periodontal disease but is not associated with other physical health problems in early midlife.

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Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review

Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review | Healthy Living & Healthy Aging Research | Scoop.it

(Available in free full text) OBJECTIVE: To quantify the dose-response relation between consumption of whole grain and specific types of grains and the risk of cardiovascular disease, total cancer, and all cause and cause specific mortality. DATA SOURCES: PubMed and Embase searched up to 3 April 2016. STUDY SELECTION: Prospective studies reporting adjusted relative risk estimates for the association between intake of whole grains or specific types of grains and cardiovascular disease, total cancer, all cause or cause specific mortality. DATA SYNTHESIS: Summary relative risks and 95% confidence intervals calculated with a random effects model. RESULTS: 45 studies (64 publications) were included. The summary relative risks per 90 g/day increase in whole grain intake (90 g is equivalent to three servings-for example, two slices of bread and one bowl of cereal or one and a half pieces of pita bread made from whole grains) was 0.81 (95% confidence interval 0.75 to 0.87; I(2)=9%, n=7 studies) for coronary heart disease, 0.88 (0.75 to 1.03; I(2)=56%, n=6) for stroke, and 0.78 (0.73 to 0.85; I(2)=40%, n=10) for cardiovascular disease, with similar results when studies were stratified by whether the outcome was incidence or mortality. The relative risks for morality were 0.85 (0.80 to 0.91; I(2)=37%, n=6) for total cancer, 0.83 (0.77 to 0.90; I(2)=83%, n=11) for all causes, 0.78 (0.70 to 0.87; I(2)=0%, n=4) for respiratory disease, 0.49 (0.23 to 1.05; I(2)=85%, n=4) for diabetes, 0.74 (0.56 to 0.96; I(2)=0%, n=3) for infectious diseases, 1.15 (0.66 to 2.02; I(2)=79%, n=2) for diseases of the nervous system disease, and 0.78 (0.75 to 0.82; I(2)=0%, n=5) for all non-cardiovascular, non-cancer causes. Reductions in risk were observed up to an intake of 210-225 g/day (seven to seven and a half servings per day) for most of the outcomes. Intakes of specific types of whole grains including whole grain bread, whole grain breakfast cereals, and added bran, as well as total bread and total breakfast cereals were also associated with reduced risks of cardiovascular disease and/or all cause mortality, but there was little evidence of an association with refined grains, white rice, total rice, or total grains. CONCLUSIONS: This meta-analysis provides further evidence that whole grain intake is associated with a reduced risk of coronary heart disease, cardiovascular disease, and total cancer, and mortality from all causes, respiratory diseases, infectious diseases, diabetes, and all non-cardiovascular, non-cancer causes. These findings support dietary guidelines that recommend increased intake of whole grain to reduce the risk of chronic diseases and premature mortality.

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USPSTF Recommendation Statement: Screening for Colorectal Cancer

USPSTF Recommendation Statement: Screening for Colorectal Cancer | Healthy Living & Healthy Aging Research | Scoop.it

(Available in free full text) Importance  Colorectal cancer is the second leading cause of cancer death in the United States. In 2016, an estimated 134 000 persons will be diagnosed with the disease, and about 49 000 will die from it. Colorectal cancer is most frequently diagnosed among adults aged 65 to 74 years; the median age at death from colorectal cancer is 68 years.Objective  To update the 2008 US Preventive Services Task Force (USPSTF) recommendation on screening for colorectal cancer.  Evidence Review  The USPSTF reviewed the evidence on the effectiveness of screening with colonoscopy, flexible sigmoidoscopy, computed tomography colonography, the guaiac-based fecal occult blood test, the fecal immunochemical test, the multitargeted stool DNA test, and the methylated SEPT9 DNA test in reducing the incidence of and mortality from colorectal cancer or all-cause mortality; the harms of these screening tests; and the test performance characteristics of these tests for detecting adenomatous polyps, advanced adenomas based on size, or both, as well as colorectal cancer. The USPSTF also commissioned a comparative modeling study to provide information on optimal starting and stopping ages and screening intervals across the different available screening methods.  Findings  The USPSTF concludes with high certainty that screening for colorectal cancer in average-risk, asymptomatic adults aged 50 to 75 years is of substantial net benefit. Multiple screening strategies are available to choose from, with different levels of evidence to support their effectiveness, as well as unique advantages and limitations, although there are no empirical data to demonstrate that any of the reviewed strategies provide a greater net benefit. Screening for colorectal cancer is a substantially underused preventive health strategy in the United States.  Conclusions and Recommendations  The USPSTF recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years (A recommendation). The decision to screen for colorectal cancer in adults aged 76 to 85 years should be an individual one, taking into account the patient’s overall health and prior screening history (C recommendation).

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Effects of Triple P parenting intervention on child health outcomes for childhood asthma and eczema: Randomised controlled trial

Effects of Triple P parenting intervention on child health outcomes for childhood asthma and eczema: Randomised controlled trial | Healthy Living & Healthy Aging Research | Scoop.it

Childhood chronic health conditions have considerable impact on children. We aimed to test the efficacy of a brief, group-based parenting intervention for improving illness-related child behaviour problems, parents’ self-efficacy, quality of life, parents’ competence with treatment, and symptom severity. A 2 (intervention vs. care as usual) by 3 (baseline, post-intervention, 6-month follow-up) design was used, with random group assignment. Participants were 107 parents of 2- to 10-year-old children with asthma and/or eczema. Parents completed self-report questionnaires, symptom diaries, and home observations were completed. The intervention comprised two 2-h group discussions based on Triple P. Parents in the intervention group reported (i) fewer eczema-related, but not asthma-related, child behaviour problems; (ii) improved self-efficacy for managing eczema, but not asthma; (iii) better quality of life for parent and family, but not child; (iv) no change in parental treatment competence; (v) reduced symptom severity, particularly for children prescribed corticosteroid-based treatments. Results demonstrate the potential for brief parenting interventions to improve childhood chronic illness management, child health outcomes, and family wellbeing. Effects were stronger for eczema-specific outcomes compared to asthma-specific outcomes. Effects on symptom severity are very promising, and further research examining effects on objective disease severity and treatment adherence is warranted.

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Association Between Midlife Cardiorespiratory Fitness and Risk of Stroke

Association Between Midlife Cardiorespiratory Fitness and Risk of Stroke | Healthy Living & Healthy Aging Research | Scoop.it

Background and Purpose— Low cardiorespiratory fitness (CRF) is associated with an increased risk of stroke. However, the extent to which this association is explained by the development of stroke risk factors such as diabetes mellitus, hypertension, and atrial fibrillation is unknown. We evaluated the relationship between midlife CRF and risk of stroke after the age of 65 years, independent of the antecedent risk factor burden.  Methods— Linking participant data from the Cooper Center Longitudinal Study with Medicare claims files, we studied 19 815 individuals who survived to receive Medicare coverage from 1999 to 2009. CRF estimated at baseline by Balke treadmill time was analyzed as a continuous variable (in metabolic equivalents) and according to age- and sex-specific quintiles (Q1=low CRF). Associations between midlife CRF and stroke hospitalization after the age of 65 years were assessed by applying a proportional hazards recurrent events model to the failure time data with hypertension, diabetes mellitus, and atrial fibrillation as time-dependent covariates.  Results— After 129 436 person-years of Medicare follow-up, we observed 808 stroke hospitalizations. After adjustment for baseline risk factors, higher midlife CRF was associated with a lower risk of stroke hospitalization (hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.49–0.76; quintiles 4–5 versus 1]. This association remained unchanged after additional adjustment for burden of Medicare-identified stroke risk factors (hypertension, diabetes mellitus, and atrial fibrillation; HR, 0.63; 95% CI, 0.51–0.79; quintiles 4–5 versus 1).  Conclusions— There is a strong, inverse association between midlife CRF and stroke risk in later life independent of baseline and antecedent burden of risk factors, such as hypertension, diabetes mellitus, and atrial fibrillation.

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Enrichment of Macular Pigment Enhances Contrast Sensitivity in Subjects Free of Retinal Disease

Enrichment of Macular Pigment Enhances Contrast Sensitivity in Subjects Free of Retinal Disease | Healthy Living & Healthy Aging Research | Scoop.it

(Available in free full text) PURPOSE: The high-performance visual function associated with central vision is mediated by the macula (the central retina), which accumulates three diet-derived pigments (the carotenoids lutein [L], zeaxanthin [Z], and meso-zeaxanthin [MZ]). Our study sought to investigate the impact on visual function, including contrast sensitivity (CS), of supplementation with these naturally occurring carotenoids, in individuals with low retinal concentrations. METHODS: Subjects consumed daily a formulation containing 10 mg L, 2 mg Z, and 10 mg MZ (active group; n = 53) or placebo (n = 52) for a period of 12 months. Study visits were at baseline, 3, 6, and 12 months. Contrast sensitivity at 6 cycles per degree (cpd) was the primary outcome measure (POM). Secondary outcome measures included CS at other spatial frequencies, best-corrected visual acuity (BCVA), glare disability, photostress recovery, and light scatter. Macular pigment optical density (MPOD) was measured using dual-wavelength autofluorescence, and serum carotenoid concentrations were analyzed using high performance liquid chromatography (HPLC). RESULTS: Compared to placebo, statistically significant improvements from baseline CS were detected at 6 (P = 0.002) and 1.2 (P = 0.004) cpd in the active group. Additionally, improvements in CS were commensurate with the observed increases in retinal concentrations of these carotenoids (r = 0.342, P = 0.002 at 6 cpd). CONCLUSIONS: These results indicate that dietary fortification with the macular carotenoids can have meaningful effects on visual function.  [See an interesting BBC discussion of this work at http://www.bbc.co.uk/news/magazine-37281200].

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Saying “No” to Cake or “Yes” to Kale: Approach and Avoidance Strategies in Pursuit of Health Goals

Saying “No” to Cake or “Yes” to Kale: Approach and Avoidance Strategies in Pursuit of Health Goals | Healthy Living & Healthy Aging Research | Scoop.it

In developing plans for achieving health-related goals, two fundamentally different strategies are often used: focusing on healthy foods that one should include in their diet, such as kale (referred to as “approach”), and focusing on unhealthy foods that one should exclude from their diet, such as cake (referred to as “avoidance”). The present research examines the differential effectiveness of approach- and avoidance-based strategies across levels of self-control, highlighting differences in food choices. The results reveal that those low in self-control focus on avoidance items they really like and approach items that are less appealing, while those higher in self-control show an opposite pattern, leading to more-motivating plans. In addition, the results show that the self-control by strategy type interaction on liking leads to differences in propensity to choose healthy items. Overall, this research highlights the importance of understanding differences in the implementation of commonly recommended strategies to improve one's health and wellness.  [And see the excellent BPS Research Digest discussion of this paper at https://digest.bps.org.uk/2016/08/18/people-with-high-self-control-have-a-cunning-approach-to-healthy-eating/#more-8197].

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The interaction of testosterone and cortisol is associated with attained status in male executives.

Are hormone levels associated with the attainment of social status? Although endogenous testosterone predicts status-seeking social behaviors, research suggests that the stress hormone cortisol may inhibit testosterone’s effects. Thus, individuals with both high testosterone and low cortisol may be especially likely to occupy high-status positions in social hierarchies while individuals with high testosterone and high cortisol may not. We tested this hypothesis by recruiting a sample of real executives and examining testosterone, cortisol, and a concrete indicator of attained status: the number of subordinates over which the executive has authority. Despite the myriad nonhormonal factors that determine organizational promotion, the executives’ endogenous testosterone and cortisol interacted to significantly predict hierarchical position: Testosterone positively predicted executives’ number of subordinates, but only among low-cortisol executives. The results imply that reducing cortisol levels via stress reduction may be a critical goal not only because doing so will improve health but also because doing so may enhance leadership potential. 

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Health Inequality Project

How can we reduce disparities in health?  The Health Inequality Project uses big data to measure differences in life expectancy by income across areas and identify strategies to improve health outcomes for low-income Americans. To learn more, see this short video, our executive summary, or our paper in the Journal of the American Medical Association.

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Adult attachment and perceptions of closeness

Adult attachment and perceptions of closeness | Healthy Living & Healthy Aging Research | Scoop.it

An online sample of more than 150,000 participants was used to examine whether—in addition to predicting how much intimacy people want—attachment styles also predict how people define and perceive intimacy. Results indicated that, as compared with relatively secure individuals, people with high levels of attachment anxiety required more time, affection, and self-disclosure to construe a relationship as “close.” Additionally, anxious individuals perceived less intimacy in relationship vignettes than did their less anxious peers. In contrast, highly avoidant individuals required less time, affection, and self-disclosure to define a relationship as “close,” and they perceived more intimacy in vignettes than did their more secure peers. These findings indicate that people who are relatively anxious not only want more intimacy in their relationships, but they are also less likely to perceive intimacy, as compared with their less anxious peers. Conversely, people high in avoidance not only want less intimacy, but they are also more sensitive to its presence, as compared with their less avoidant peers.

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Estimation of the dietary requirement for vitamin D in white children aged 4–8 y: a randomized, controlled, dose-response trial

Background: Children in northern latitudes are at high risk of vitamin D deficiency during winter because of negligible dermal vitamin D3 production. However, to our knowledge, the dietary requirement for maintaining the nutritional adequacy of vitamin D in young children has not been investigated.  Objective: We aimed to establish the distribution of vitamin D intakes required to maintain winter serum 25-hydroxyvitamin D [25(OH)D] concentrations above the proposed cutoffs (25, 30, 40, and 50 nmol/L) in white Danish children aged 4–8 y living at 55°N.  Design: In a double-blind, randomized, controlled trial 119 children (mean age: 6.7 y) were assigned to 0 (placebo), 10, or 20 μg vitamin D3/d supplementation for 20 wk. We measured anthropometry, dietary vitamin D, and serum 25(OH)D with liquid chromatography–tandem mass spectrometry at baseline and endpoint.  Results: The mean ± SD baseline serum 25(OH)D was 56.7 ± 12.3 nmol/L (range: 28.7–101.4 nmol/L). Serum 25(OH)D increased by a mean ± SE of 4.9 ± 1.3 and 17.7 ± 1.8 nmol/L in the groups receiving 10 and 20 μg vitamin D3/d, respectively, and decreased by 24.1 ± 1.2 nmol/L in the placebo group (P < 0.001). A nonlinear model of serum 25(OH)D as a function of total vitamin D intake (diet and supplements) was fit to the data. The estimated vitamin D intakes required to maintain winter serum 25(OH)D >30 (avoiding deficiency) and >50 nmol/L (ensuring adequacy) in 97.5% of participants were 8.3 and 19.5 μg/d, respectively, and 4.4 μg/d was required to maintain serum 25(OH)D >40 nmol/L in 50% of participants.  Conclusions: Vitamin D intakes between 8 and 20 μg/d are required by white 4- to 8-y-olds during winter in northern latitudes to maintain serum 25(OH)D >30–50 nmol/L depending on chosen serum 25(OH)D threshold.

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November: CBT, Stress & Well-Being Relevant Research, Blog Posts & Other Resources

November: CBT, Stress & Well-Being Relevant Research, Blog Posts & Other Resources | Healthy Living & Healthy Aging Research | Scoop.it

Early November and here’s an autumn newsletter with abstracts & links to many recently published research articles relevant to CBT & psychotherapy, depression, mindfulness & compassion, healthy living & healthy aging, and positive psychology (and photos from last weekend's walk up Kinnoull Hill in Perth).  There are also eight blog posts.  Five are inspired by thoughts about how we could increase the effectiveness of psychotherapy.  A couple are about kidney donation (an unusual subject for this newsletter, but a current personal journey), and one is a post on recent research that has been published in the last few months (see below).  Finally there are links to a library of freely downloadable handouts, questionnaires, and courses.  All information described in this newsletter is offered as a free resource for health professionals and for others interested in evidence-based approaches to stress, health & well-being.  If you no longer wish to receive these mailings, please use this link to unsubscribe.  If you would like to update your contact details or ask for the newsletter to be sent to a friend or colleague as well please follow this link.  I hope you’ll find that this mailing is interesting & useful for you both professionally & personally.

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Prenatal Nicotine Exposure and Risk of Schizophrenia Among Offspring in a National Birth Cohort

Prenatal Nicotine Exposure and Risk of Schizophrenia Among Offspring in a National Birth Cohort | Healthy Living & Healthy Aging Research | Scoop.it

Objective: Cigarette smoking during pregnancy is a major public health problem leading to adverse health outcomes and neurodevelopmental abnormalities among offspring. Its prevalence in the United States and Europe is 12%–25%. This study examined the relationship between prenatal nicotine exposure (cotinine level) in archived maternal sera and schizophrenia in offspring from a national birth cohort.  Method:The authors conducted a population-based nested case-control study of all live births in Finland from 1983 to 1998. Cases of schizophrenia in offspring (N=977) were identified from a national registry and matched 1:1 to controls on date of birth, sex, and residence. Maternal serum cotinine levels were prospectively measured, using quantitative immunoassay, from early- to mid-gestation serum specimens archived in a national biobank.  Results:A higher maternal cotinine level, measured as a continuous variable, was associated with an increased odds of schizophrenia (odds ratio=3.41, 95% confidence interval, 1.86–6.24). Categorically defined heavy maternal nicotine exposure was related to a 38% increased odds of schizophrenia. These findings were not accounted for by maternal age, maternal or parental psychiatric disorders, socioeconomic status, and other covariates. There was no clear evidence that weight for gestational age mediated the associations.  Conclusions:To the authors’ knowledge, this is the first study of the relationship between a maternal smoking biomarker and schizophrenia. It provides the most definitive evidence to date that smoking during pregnancy is associated with schizophrenia. If replicated, these findings suggest that preventing smoking during pregnancy may decrease the incidence of schizophrenia.

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Who is having more and better sex? The Big Five as predictors of sex in marriage

Prior research has been somewhat inconsistent in demonstrating links between personality and sexual functioning. We pooled the data from three independent daily-diary studies of newlywed couples to examine the association between individuals’ Big Five traits and the probability of sex on a given day; we also pooled the data from the two studies that assessed satisfaction with sex to examine the association between these traits and individuals’ satisfaction with sex when it occurred. Couples with wives high in agreeableness engaged in more frequent sex. Husbands low in openness or neuroticism and wives low in neuroticism reported increased satisfaction with sex when it occurred. Partner personality was unrelated to satisfaction with sex when it occurred.

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Daily goal progress is facilitated by spousal support and promotes psychological, physical, and relational well-being throughout adulthood.

In 2 daily diary studies, we tested the consequences and precursors of daily goal progress throughout the adult life span. Attachment theory posits that exploration—including the pursuit of autonomous goals—promotes well-being across the life span and is facilitated by support from close others. For both young-adult newlyweds (Study 1) and married couples in late adulthood (Study 2), daily independent goal progress predicted same-day and next-day improvements in psychological, physical, and relational well-being. Specifically, when participants made more progress on their goals than usual on one day, they reported increases in positive affect, sleep quality, and relationship quality, and decreased physical symptoms, the following day (as well as concurrently). Additionally, spousal support (i.e., availability, encouragement, and noninterference) enabled same-day and next-day goal progress. Mediational analyses showed indirect links between spousal support and well-being through goal progress. Some effects were moderated by attachment orientation in the newlywed sample; individuals with greater insecure attachment benefited most from goal progress, and spousal support enabled goal progress most strongly for individuals with less anxious attachment. Overall, these results support and extend attachment theoretical propositions regarding the importance of the exploration system across the adult life span. They contribute to existing literature by demonstrating wide-ranging consequences of successful exploration for well-being and by providing evidence for the importance of both exploration and support for exploration into late adulthood. 

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Factors contributing to depressive mood states in everyday life: A systematic review

Factors contributing to depressive mood states in everyday life: A systematic review | Healthy Living & Healthy Aging Research | Scoop.it

Background Although accumulated evidence suggests that fluctuations in depressed mood are common among individuals with depression, and may be associated with onset, duration, and severity of illness, a systematic appraisal of putative predictors of depressed mood is lacking. Methods A systematic search for relevant studies in the literature was conducted using PsycInfo and PubMed databases via EbscoHost in February 2016. The search was limited to articles using the experience sampling method, an approach suitable for capturing in situ fluctuations in mood states. Results Forty-two studies met inclusion criteria for the review, from which three key risk factors (poor sleep, stress, and significant life events) and two protective factors (physical activity and quality of social interactions) were identified. The majority of papers supported concurrent and lagged associations between these putative protective/risk factors and depressed mood. Limitations Despite support for each of the proposed protective/risk factors, few studies evaluated multiple factors in the same study. Moreover, the time course for the effects of these predictors on depressed mood remains largely unknown. Conclusions The present review identified several putative risk and protective factors for depressed mood. A review of the literature suggests that poor sleep, negative social interactions, and stressful negative events may temporally precede spikes in depressed mood. In contrast, exercise and positive social interactions have been shown to predict subsequent declines in depressed mood. However, the lack of multivariate models in which the unique contributions of various predictors could be evaluated means that the current state of knowledge prevents firm conclusions about which factors are most predictive of depressed mood. More complex modeling of these effects is necessary in order to provide insights useful for clinical treatment in daily life of the depressed mood component of depressive disorders.

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Light therapy as a treatment for sexual dysfunction; focus on testosterone levels

Light therapy as a treatment for sexual dysfunction; focus on testosterone levels | Healthy Living & Healthy Aging Research | Scoop.it

Paper given on 19th September at the 29th European College of Neuropsychopharmacology (ECNP) Congress in Vienna:

 Seasonality has shown to have a significant influence on sexual function and the pineal gland plays a key role in the neuroendocrine control of sexual activity. The retinohypothalamic tract carries information on the cycles light/dark to the suprachiasmatic nucleus of the hypothalamus that projects to the pineal gland and inhibits the production of melatonin [1]. When these impulses stop (at night, when light no longer stimulates the hypothalamus), pineal inhibition ceases and melatonin is released. Melatonin increases the secretion of prolactin, which contributes to sexual dysfunction. We aimed at demonstrating that inhibition of the pineal gland activity through a light treatment may favorably affect sexual function reducing plasma levels of melatonin. We recruited a sample of 38 male subjects among outpatients referred to the Urology Department of the University of Siena on the basis of a diagnosis of primary hypoactive sexual desire disorder (HSDD) and sexual arousal disorder (SAD). Participants were randomly assigned to active light treatment (ALT) or placebo light treatment (L-PBO) and assessed before and after 2 weeks of treatment ALT/L-PBO via the Structured Clinical Interview for DSM-IV sexual disorders (SCID-d) and self-administered rating scale of the level of sexual satisfaction (1 to 10); testosterone levels were also assessed at baseline and after two weeks of treatment through blood samples. The ALT consisted of daily exposure to a white fluorescent light box (Super-Lite 3S), fitted with an ultraviolet filter and rated at 10,000 lx at a distance of 1 meter from screen to cornea for 30 min as soon as possible after awakening, between 7.00 a.m. and 8.00 a.m. The L-PBO was an identical light box fitted with a neutral density gel filter to reduce light exposure to 100 lx. The Mann–Whitney test for nonparametric data has been applied to analyze the differences between the ALT and L-PBO group at the time of recruitment and after 2 weeks of therapy. At baseline the two groups were clinically comparable; results after 2 weeks of therapy showed a significant improvement in sexual satisfaction in the group treated with ALT approximately 3 times higher than the group that received the placebo (p < 0.05), while no significant improvement was observed in the group L-PBO. Testosterone levels (range 2.7–10.9 ng/ml) at baseline were 2.1±1.3 ng/ml in ALT and 2.3±0.6 ng/ml in L-PBO group; after two weeks they raised at 3.6±1.1 ng/ml in ALT group (p < 0.05) while no significant difference emerged in L-PBO group. Our results suggest that the level of sexual satisfaction at baseline was roughly comparable in the two groups, with no statistically significant differences. After 2 weeks of treatment the group that received ALT showed a significant improvement in sexual function with respect to baseline level, about 3 times higher than the group that received L-PBO. This difference could also be attributed to increased levels of testosterone in subjects treated with active light therapy.  [Medscape comment: Study investigator Andrea Fagiolini, MD, chairman, Division of Psychiatry, University of Siena School of Medicine, Italy, told Medscape Medical News that "Although it cannot be said at this time that light therapy will replace Viagra, we did see a very strong effect."  The investigators plan to repeat the study with larger numbers of patients.  "The good thing is that it's basically safe. Unless people have some eye problems, it's really unlikely that this gives problems, whereas any medication has much more problems in terms of side effects and dangerous interactions with other medications," he said.  "Even if I would recommend not to use it until we have results from larger trials, if somebody wants to use it, it's not going to give too many problems, because it is a treatment that is already used for another disorder, and we know it's pretty safe," Dr Fagiolini added ... After 2 weeks of therapy, individuals who received active light treatment had experienced significant improvements in sexual satisfaction compared with those receiving placebo light treatment (P < .05) ... "The increased levels of testosterone explain the greater reported sexual satisfaction. In the Northern hemisphere, the body's testosterone production naturally declines from November through April and then rises steadily through the spring and summer, with a peak in October," said Dr Fagiolini.  "You see the effect of this in reproductive rates, with the month of June showing the highest rate of conception. The use of the light box really mimics what nature does. We believe that there may be several explanations to explain the underlying mechanism. For instance, light therapy inhibits the pineal gland in the center of the brain, and this may allow the production of more testosterone, and there are probably other hormonal effects."  Cautionary Note: Commenting on the findings, Eduard Vieta, MD, PhD, chair of the Department of Psychiatry and Psychology at the University of Barcelona Hospital Clinic, Spain, who is treasurer of the ECNP, commented that "light therapy has been used successfully in the past to treat some forms of depression, and this study suggests now that it may also work to treat low sexual desire in men. The mechanism of action appears to be related to the increase of testosterone levels," he said.  However, Dr Vieta sounded a note of caution over its use at this stage for the treatment of low sexual desire.  "Before this kind of treatment, which is likely to be better tolerated than pharmacological therapy, gets ready for routine use, there are many steps to be implemented, including replication of the results in a larger, independent study and verifying whether the results are long-lasting and not just short-term," he said.]

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Long-term effects of weight reduction on the severity of psoriasis in a cohort derived from a randomized trial: a prospective observational follow-up study

Background: Weight reduction may reduce the severity of psoriasis, but little is known about the long-term effects.  Objective: We aimed to investigate long-term effects of weight reduction in psoriasis.  Design: We previously conducted a randomized trial (n = 60) involving patients with psoriasis who were allocated to a control group or a low-energy diet (LED) group. Here we followed the participants for an additional 48-wk period. In total, 56 patients with psoriasis [mean ± SD body mass index (in kg/m2): 34.4 ± 5.3] underwent a 64-wk weight-loss program consisting of an initial 16-wk randomized phase with an LED for 8 wk and 8 wk of normal food intake combined with 2 LED products/d, followed by a 48-wk period of weight maintenance with the latter diet. After the randomization phase, the control group received the same 8 + 8-wk LED intervention, and all patients were then followed for 48 wk while on the weight-loss maintenance diet. The main outcome was the Psoriasis Area and Severity Index (PASI), and secondary outcome was the Dermatology Life Quality Index (DLQI).  Results: For the present study, 56 patients were eligible, 38 agreed to participate, and 32 completed. After the 16-wk LED-only period, the mean weight loss was −15.0 kg (95% CI: −16.6, −13.4 kg), and PASI and DLQI were reduced by −2.3 (95% CI: −3.1, −1.5) and −2.3 (95% CI: −3.2, −1.4), respectively. At week 64, the mean weight loss compared with baseline was −10.1 kg (95% CI: −12.0, −8.1 kg), and PASI and DLQI were maintained at −2.9 (95% CI: −3.9, −1.9) and −1.9 (95% CI: −3.0, −0.9), respectively.  Conclusion: Long-term weight loss in patients with psoriasis has long-lasting positive effects on the severity of psoriasis.

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New Cochrane review: Vitamin D for the management of asthma

New Cochrane review: Vitamin D for the management of asthma | Healthy Living & Healthy Aging Research | Scoop.it

Review question

Does vitamin D prevent asthma attacks or improve control of asthma symptoms or both?

Background

Low blood levels of vitamin D (the 'sunshine vitamin') have been linked to an increased risk of asthma attacks in children and adults with asthma. Several clinical trials have been conducted to test whether vitamin D might prevent asthma attacks and improve control of asthma symptoms in children and adults, but results from studies with the most scientifically sound designs have not previously been evaluated as a group.

Included studies

We included seven trials involving 435 children and two trials involving 658 adults in the review from searches run up to January 2016. Of these, one trial involving 22 children and two trials involving 658 adults contributed to the analysis of the rate of severe asthma attacks. Study duration ranged from four to 12 months, and the majority of those taking part had mild or moderate asthma. All of the studies compared vitamin D with placebo.

Key results

People given vitamin D experienced fewer asthma attacks needing treatment with oral steroids. The average number of attacks per person per year went down from 0.44 to 0.22 with vitamin D (high-quality evidence). Vitamin D reduced the risk of attending hospital with an acute asthma attack from 6 per 100 to around 3 per 100 (high-quality evidence).

Vitamin D had little or no effect on lung function or day-to-day asthma symptoms (high-quality evidence). We found that vitamin D did not increase the risk of serious adverse events at the doses that were tested (moderate-quality evidence).

We based all of these findings on studies judged to be of high quality.

Conclusion

Vitamin D is likely to offer protection against severe asthma attacks. Further trials focusing on children and people who experience frequent severe asthma attacks are needed before definitive clinical recommendations can be made.

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Why small talk is so excruciating

Why small talk is so excruciating | Healthy Living & Healthy Aging Research | Scoop.it

We often confuse the information exchange function of conversation with the social connection function.  Both are important.  Let's hear it for "small talk".  We'd probably be happier ... and make others happier ... if we indulged in it more ... in shops, on transport, at our classes ... let small talk break out!

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Grief following pet and human loss: Closeness is key

Grief following pet and human loss: Closeness is key | Healthy Living & Healthy Aging Research | Scoop.it

The authors compared grief severity and its predictors in two equivalent college student samples who had experienced the death of a pet (n = 211) or a person (n = 146) within the past 2 years. The human death sample reported higher grief severity, p < .01, but effect sizes were small (ds = .28–.30). For both samples, closeness to the deceased was overwhelmingly the strongest predictor of grief severity; other predictors generally dropped out with closeness added to the model. Results highlight the importance of including closeness to deceased in grief research, and its centrality in understanding grief counseling clients.

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